Standing Orders - URGENT!

teeniebert, LPN · Jul 21, 2011

have you tried the Association of Camp Nurses site? http://www.acn.org/

hotflashion, BSN, RN · Jul 21, 2011

I saved a copy of the standing orders used at my camp. I'm willing to get these to the original poster. Let me think of how to do it.

I can't think of any reason why I should not just type them in here. Can anyone else think of why that would not be a good idea? Allnurses staff is this allowed? Obviously, I will remove any identifying information.

campmonkey · Jul 21, 2011

Thank you hotflashion. I sent you an email with my email adress if you want to send it my way!

boondocks · Aug 2, 2011

I would really appreciate you forwarding me the email, too, if it's not too much trouble.

[email protected]

thanks!

taniajks · Feb 20, 2012

hey i am new to this sort of forum, but I am in search of standing orders. maybe this conversation is way too old, but i would love it if someone could send some standing orders my way! email is [email protected]

nurseprnRN, BSN, RN · Mar 12, 2012

the aca should be able to help you. also, all boy scout camps with residential programs (think: 1 week summer camp sessions) are required to have a health officer and md backup, and there are always standing orders. call your local bsa council (they are in the phone book) and ask to speak to the physician who is their camp back-up.

in my opinion, hotflashion, there would be nothing wrong with transcribing your standing orders here, with identifying data removed, and it would be very helpful.

Asira · Mar 18, 2012

I would love to see this as well as a new nurse working in a residential facility. :] [email protected]

Thank you so much!

jenriske · Apr 12, 2012

I'd love to have that list of orders too if it's still available. I'm heading to NY for a camp next month. Thanks!

[email protected]

hotflashion, BSN, RN · Apr 15, 2012

Ok, here are the standing orders we used at the camp I worked at. All identifying information has been removed.

Date:

Consulting physician or practice name

Address

Hours of operation/availability

Telephone

Fax number

STANDING ORDERS

Anaphylaxis

This is an acute, rapid reaction to exposure to an allergen. This can be in the form of hives, angioedema, bronchospasm, stridor, hypotension, and anaphylactic shock. Common allergens include bee stings, foods (e.g. nuts, eggs) and medications. If only hives occur in a stable individual who is in no distress, Benadryl 25-50mg orally can be given and that person should be monitored and MD. notified. If any respiratory distress or evidence of shock occurs (which may initially present as a feeling of impending doom), give epinephrine (1:1000) 0.01mg/Kg, max 0.3 ml or Epi-pen subcutaneously and activate emergency medical services (EMS) immediately. May repeat Epi-pen every 20 minutes until EMS arrives. If in doubt, give Epi-pen. ***For patient with known nut allergy, it is generally recommended to give epinephrine for known exposure and not wait for symptoms.***

Asthma

Asthma causes recurrent and usually reversible bronchospasm. The vast majority of children will already be diagnosed when they present with symptoms and will have a drug regimen for acute exacerbations. If this is the case, they will know their disease best. If they are not satisfactorily improved with their drug regimen, notify MD. If an individual presents with wheezing in the absence of any previous history of the same, it is not prudent to assume this is from asthma. If in little or no distress, notify MD. If in significant distress, provide oxygen if available and call EMS.

Bites

Bee, wasp or hornet stings. Prevention is critical. Always wear shoes. Avoid brightly colored clothing, perfumes or scented soaps and sprays. Avoid garbage or orchards where these insects are attracted. If a child has a history of sting allergy, give Benadryl (1mg/Kg) to a maximum of 50mg and observe for one hour. If any signs of a generalized reaction (wheezing, stridor, shock, generalized hives), give epinephrine as under “Anaphylaxis,” and activate EMS. If stinger remains (bee only), remove promptly, ideally by scraping off. Apply hydrocortisone cream 1% if available and apply ice. If significant hives occur, call MD.

Other insect or spider bites. Wash with soap and water, apply cold compress, 1% hydrocortisone cream 2 or 3 times daily and Benadryl (1mg/Kg) to a maximum of 50mg, every 6 hours, for itching. Watch for signs of infections: increasing redness, swelling, pain or discharge.

Snake bites. Identify snake if at all possible. If envenomation has occurred, the extremity should be splinted to reduce motion. Keep the patient quiet and warm and transport to hospital.

Animal bites. Identify species of biting animal (capture if feasible), health status if domestic animal, note whether attack was provoked or unprovoked, and determine patient’s tetorifice immunity. If wound is on hand or face, extensive, or there is any concern of rabies, contact MD. If last tetorifice vaccine >5 years ago, the patient should receive a tetorifice booster within 24-48 hours. If very minor bite, wash with soap and water and apply antibiotic ointment, watch for signs of infection. ***Need to consider risk of rabies.***

Bleeding

Apply direct pressure to bleeding site with sterile gauze or clean cloth if gauze not available. If bleeding is profuse, activate EMS. As in all situations, exercise universal precautions with the use of gloves and mask, etc.

Burns

Burns can occur in various ways, but generally flushing the burn area with clean, cool water immediately to minimize thermal injury is the best first step. Then evaluate the patient. If the skin is red but intact (first degree burn), the area will be painful but the injury is not immediately serious. Cool, wet compresses and ibuprofen 10mg/Kg (up to 400mg) every 6 hours will help relieve pain. Protect burn area from sunlight. Moisturizers with aloe will help keep skin from drying and cracking. If there are areas of blistering or question of deep involvement, notify MD. Leave blisters intact. If the patient has extensive burns, seems unstable or there is a question of smoke inhalation, activate EMS.

Colds and Upper Respiratory Infections (URI)

Document fever, pharyngitis, productive cough, duration of symptoms. For nasal congestion, saline nasal spray PRN, at least 6 times daily. Acetaminophen for fever or achiness. For cough disturbing sleep, Robitussin DM or Benadryl may be given. Encourage adequate rest and increased fluids. Consult MD. for earache, fever > 102 for > 3 days, URI symptoms greater than 10-14 days, or if individual appears worrisomely ill.

Constipation

Hard, dry painful stooling of infrequent stooling with discomfort. Document diet, stooling pattern, normal abdominal exam. Increase fluids, decrease milk, cheese, rice, and bananas. Try prunes, prune or apple juice, molasses. Milk of magnesia, 30 ml every night and then 15 ml twice a day until regulated. If not resolving or patient is in a lot of pain, call MD. Also try Miralax.

Diarrhea or Frequent Stools with Increased Water

Document stool pattern, fever, cramping, blood in stool, recent diet. If abdominal exam normal and no vomiting, offer starchy foods and clear liquids such as Gatorade, ginger ale, or cola. Avoid soda with caffeine, apple or pear juice, tea or coffee, milk. Yogurt with active cultures may help.

Vomiting

If repeated vomiting present, give clear liquids initially then starchy diet. Watch for adequate urination, blood in stool, abdominal pain. If vomiting > 24 hrs., or significant abdominal pain (especially in lower right quadrant) consult MD. Consult MD. if concerned.

Fever

Any temperature greater than 101 degrees, camper should remain in infirmary until without fever for 24 hours. Fever > 101.5 degrees may be treated with either acetaminophen 15mg/Kg or ibuprofen 10mg/Kg every 6-8 hours. Fever of more than 3 days should be evaluated by MD. Fever > 104 degrees should be evaluated by MD.

Fracture

Obvious deformity of bone or area of point tenderness, with or without swelling after an injury. Document intact distal pulse and strength. Apply cold compress. Splint any suspected fracture, if possible. Elevate extremity. If open fracture, apply sterile dressing then ice compress. Consult MD. Activate EMS if transporting individual is problematic.

Frostbite

Document skin color change after exposure to cold. Skin may be white, gray, purple, glossy. May be numb or intensely painful. Notify MD unless it appears trivial.

Headache

Document location, quality or character of pain (throbbing, stabbing, sharp, etc.), duration, associated nausea or vomiting, any history of head injury. If no history of injury, no signs of infection and exam is normal, give ibuprofen every 6-8 hours or acetaminophen every 4 hours. If headache is severe or lasts > 24 hours or associated with fever, consult MD.

Head Injury

Document loss of consciousness, nature of injury or event, if individual is oriented to place, person, and time, memory loss (before or after event), presence of bleeding or discharge from ears or nose, presence of seizures. Check vital signs (pulse, blood pressure, respirations), mental status or level of consciousness, presence of neck injury. If there is a bleeding scalp wound, cover and apply pressure, elevate head. Avoid neck flexion if and neck injury possible. Cold compress to site of injury. Consult MD for any laceration, loss of consciousness, immobilize neck and call EMS. Any loss of consciousness or altered mental status consistent with a concussion should be evaluated.

Head Lice

Nits attached to hair shaft. Very itchy scalp. Rx: Nix cream rinse after clarifying shampoo (removes all other conditioners). Remove all nits with nit comb. Launder clothing, linens. Clean items used on head. Consult MD if it persists.

Heat Exhaustion

Caused by exposure to a high-temperature environment with continuous sweating and lack of appropriate replenishment of water or salt. Presents with fatigue, weakness, headache, anxiety. Sweating may be present. Rectal temp 104.5, cool body and treat as heat stroke.

Heat Stroke

Extremely high body temperature > 104-105 with absence of sweating. Heat stroke is life threatening. Remove patient from heat, undress and place in tub of cool water. Activate EMS.

Infections of Skin

Document type of lesion, presence of discharge, redness, warmth, tenderness. If yellow crusting but localized, wash with antibacterial soap and apply antibacterial ointment three times daily. If spreading area or widespread, consult MD. If cluster of small blisters, consider possible herpes and consult MD. Do not open blisters! If suspect impetigo, see MD. If fluctuant furuncle, may be MRSA and should be evaluated by MD.

Otitis Externa

Also known as “swimmer’s ear.” Inflammation of ear canal characterized by pain with movement of pinna or tragus, itching of canal; discharge, redness, and/or swelling of canal. Consult with MD. For children prone to swimmer’s ear (without tubes or TM perforation), use plain VoSol or Star Otic 3-4 drops after swimming and at bedtime to prevent recurrence.

Otitis Media

Infection of the middle ear space. Usually associated with URI, may be associated with fever, cervical adenopathy, loss of hearing, vomiting. Consult MD.

Poison Ivy

Skin reaction, contact dermatitis, after contact with plants in the Rhus family. Itchy, red, blistering rash often with linear lesions. Lesions often swell and ooze. Relief measures: If weeping, apply Domeboro (aluminum acetate) or Burow’s Solution as soaks for 15 minutes 3-4 times daily till areas dry; calamine lotion PRN; 1% hydrocortisone cream 3-4 times daily; Benadryl 25mg PO 4 times a day (or 1mg/Kg to 50mg max dose). Poison ivy continues to spread through exposure to plant oils, so make sure all exposed skin and clothes have been washed well. Consult MD for widespread rash, facial or genital swelling or signs of secondary infection.

Poison Ingestion

Identify agent ingested, amount and time of ingestion. Assess state of consciousness, presence of oral lesions. Contact poison control for treatment. Have charcoal available. American Association of Poison Control Centers national hotline: 800-222-1212. Website with list of state poison offices: www.aapcc.org.

Scabies

Very itchy, with macules, wheals, burrows, excoriations. Often in web spaces of fingers. Consult MD. Launder all clothing and linens.

Seizures

A paroxysmal event resulting in abnormalities of motor, sensory, autonomic or psychic function. Document duration of seizure, types of movement seen, any eye deviation or focal findings, loss of consciousness, cyanosis, incontinence. Rx: do not forcefully restrain, do not put anything into mouth. Ensure adequate airway. Place on side to prevent aspiration. Keep patient safe. Consult MD and/or activate EMS. If seizure > 3 minutes, activate EMS.

Sore Throat

Document fever, presence of adenopathy, rash, difficulty swallowing or breathing. May use Chloraseptic spray or lozenges. Acetaminophen, increased fluids, cool mist. If symptoms increase or persist 2-4 days, or individual appears ill, consult MD.

Sunburn

Best treatment is prevention. Use sun block with SPF > 15 if individual is to be in sun > 5 minutes from 10a-3p and reapply often. Sunburn is injury to skin caused by overexposure to sun. Document degree of burn. First degree: simple redness. Second degree: blistering. Rx: Apply cool compresses. Moisturizing cream to 1^st degree burns. Second degree burns, treat as burn from any source: topical antibiotic ointment. Leave blisters intact! If extensive and/or associated with systemic symptoms (e.g., fever, chills) consult MD.

Ticks and Lyme Disease

If tick is removed within 24-36 hours, Lyme Disease is rare; daily tick checks by campers are a good preventive measure. Remove tick by grasping at the head with tweezers and pulling with constant gentle pressure. If head detaches in process, this is NOT a problem, simply dress with antibiotic ointment and band aid. Symptoms to watch for over the next month include fever, headache, and rash at tick bite site OR anywhere, and joint pain. Call MD if these occur. If tick on > 36 hours, call MD; may receive prophylactic doxycycline.

Storage and Administration

As health care consultants, we have ordered all prescription medications to be kept locked and in their original container. Any camper bringing medication from home must bring the medication in its original container along with a note from the parent allowing the camp nurse to administer the medication. The ordering physician’s name, address, phone number and prescribing instructions must accompany each prescription brought to camp. Any camper who arrives at camp without this mandatory information must clarify this information prior to admission to camp.